Strongly recommended for all pregnant women: Influenza vaccine: All pregnant women should be encouraged to receive the annual flu vaccine to protect herself and to pass antibodies to her baby. Numerous studies show no increased risk of stillbirth, preterm birth or SGA associated with the vaccine. Several studies support better obstetric outcomes for mothers who are vaccinated. Tdap: Recommended in all pregnancies between 27-36 weeks. Repeat in this time frame even if recently received. A boost in maternal antibodies crossing the placenta prior to delivery will help protect the baby from pertussis (whooping cough) in the first 2 months and is more effective than a postpartum vaccination. Inactivated versus live attenuated vaccines Generally inactivated vaccines are safe in pregnancy and live attenuated vaccines are avoided except in special circumstances where risk of disease is very high. The risk of live vaccine is primarily theoretical and related to the risk of birth defects from actual infection rather than any reported cases of inadvertent vaccination resulting in fetal birth defects. Post exposure prophylaxis with immune globulin Women exposed to Varicella or Measles may qualify for IVIG or VariZIG. If exposure reported by patient make every effort to verify validity of exposure, draw STAT titers for immunity if unknown and consult immediately (Kathy Ferris, infection control) to assess whether immune globulin warranted and/or available.
VACCINE
RECOMMENDATION
TYPE OF VACCINE
Influenza (injection) Do not give nasal version (live attenuated)
Yes. Given regardless of stage of pregnancy
Inactivated
Tdap
Yes, given each pregnancy. Ideally given between 28-37wks of pregnancy
Inactivated
Hepatitis B
Yes, if indicated Examples include patients at risk for acquiring HBV –multiple sexual partners, IVDA, household contacts of patients with Hep B. Can be given using accelerated schedule 0,1,4months.
Inactivated.
Hepatitis A
Yes, if indicated Pre exposure prophylaxis-Inactivated Hep A vaccine only Post exposure prophylaxis- Inactivated Hep A vaccine and Immune globulin.
Inactivated
Pneumococcal
Yes, if indicated. Pneumococcal polysaccharide vaccine (PPSV23). Little information about safety in first trimester. Appears safe in second and third trimesters. Ideally should be given preconception. Given to women at risk for invasive pneumococcal Infection- women with functional or anatomic asplenia- sickle cell disease and other hemoglobinopathies.
Inactivated
Yellow Fever
Yes, if indicated. But better to avoid travel to endemic areas.
Live attenuated
Polio (IPV)
Yes, if indicate. But, better to avoid travel to areas disease is present.
Inactivated
HPV
No, Under study but likely safe.
Inactivated
Haemophilus Influenza
Recommended(H. Influenza type B conjugate vaccine) for patients who did not receive childhood Hib series and are at increased risk of invasive Hib disease-pts with chronic conditions: sickle cell disease, leukemia, HIV
Inactivated
Meningococcal
Yes, if indicated. Either polysaccharide or conjugate.
Both are inactivated
Varicella or MMR
No. Give before pregnancy and avoid conception for 4wks. Given postpartum if nonimmune during pregnancy
Both are live
Rabies
Yes, if indicated
Inactivated
Typhoid injection (don’t use oral form)
Yes, if indicated. Pregnant women should avoid travelling to typhoid endemic area.
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IMMUNIZATIONS IN PREGNANCY
For updated information:
**http://www.cdc.gov/vaccines/pubs/preg-guide.htm**
Strongly recommended for all pregnant women:
Influenza vaccine: All pregnant women should be encouraged to receive the annual flu vaccine to protect herself and to pass antibodies to her baby. Numerous studies show no increased risk of stillbirth, preterm birth or SGA associated with the vaccine. Several studies support better obstetric outcomes for mothers who are vaccinated.
Tdap: Recommended in all pregnancies between 27-36 weeks. Repeat in this time frame even if recently received. A boost in maternal antibodies crossing the placenta prior to delivery will help protect the baby from pertussis (whooping cough) in the first 2 months and is more effective than a postpartum vaccination.
Inactivated versus live attenuated vaccines
Generally inactivated vaccines are safe in pregnancy and live attenuated vaccines are avoided except in special circumstances where risk of disease is very high. The risk of live vaccine is primarily theoretical and related to the risk of birth defects from actual infection rather than any reported cases of inadvertent vaccination resulting in fetal birth defects.
Post exposure prophylaxis with immune globulin
Women exposed to Varicella or Measles may qualify for IVIG or VariZIG. If exposure reported by patient make every effort to verify validity of exposure, draw STAT titers for immunity if unknown and consult immediately (Kathy Ferris, infection control) to assess whether immune globulin warranted and/or available.
Do not give nasal version (live attenuated)
Examples include patients at risk for acquiring HBV –multiple sexual partners, IVDA, household contacts of patients with Hep B.
Can be given using accelerated schedule 0,1,4months.
Pre exposure prophylaxis-Inactivated Hep A vaccine only
Post exposure prophylaxis- Inactivated Hep A vaccine and Immune globulin.
Little information about safety in first trimester. Appears safe in second and third trimesters. Ideally should be given preconception. Given to women at risk for invasive pneumococcal
Infection- women with functional or anatomic asplenia- sickle cell disease and other hemoglobinopathies.
(don’t use oral form)